Conditions Of Detention: The Use Of Isolation And Segregation

Inappropriate Use of Segregation to Treat Mental Health Issues in Detention

Unfortunately, a very high proportion of immigration detainees suffer from some form of mental illness, including a range of conditions from to schizophrenia to bipolar disorder, while many others have developmental disabilities, such as Down Syndrome. Although Immigration and Customs Enforcement (ICE) fails to maintain meaningful statistics on the exact number of detainees with mental health issues, it is estimated that at least fifteen percent may have a mental illness[1]. Many of these cases are overlooked, ignored, or inadequately treated, as health professionals working in the rapidly-expanding immigration detention system struggle to provide medical services to their growing caseload. Several recent reports by NGOs have documented the manifest flaws that exist in ICE protocol and practice for treating mentally ill and disabled people in immigration detention, but human rights violations continue to occur on a daily basis to this vulnerable, hidden population for two principle reasons: 1) most detention center staff are inadequately trained to deal with people with mental disabilities, and 2) these detainees are generally unable or afraid to advocate for themselves.

A well-known metaphor posits that “the squeaky wheel gets the grease”, but immigration detainees are well aware that “the squeaky wheel” in detention is far more likely to get segregation[2] as a punishment than to receive positive attention from security or medical staff. Detainees who complain or act out due to mental conditions beyond their control are frequently sent to segregation units or held down in restraints because staff is unable or unwilling to help them control their behavior. In many cases, security or even medical staff send mentally disabled people to solitary confinement for prolonged periods of time, where they deteriorate without access to mental health professionals or even to other detainees.

A detainee who was held in a Texas detention center for nine months, more than half of that time spent in solitary confinement, explains the horror he felt in segregation: “When they put you in ‘el pozo’ [the hole or solitary confinement] you only have a little space. You have a toilet and a little space where you can sleep. And there is a little place where they put the food, but they throw it without caring. If you don’t take it rapidly, they throw it, whether it is hot or cold. They don’t care. They throw it as if you were an animal. It makes you lose control mentally. That is why I did not come out so well, mentally. I would lose my mind – I would lose my mind severely. I even wanted to commit suicide.”[3]

Health professionals should always try to implement the least restrictive measures necessary to control a patient’s behavior, and assignment to a segregation unit is not appropriate in the absence of a therapeutic goal (related to time spent in segregation) for the patient. Sending detainees to segregation is not meant to be a solution for dealing with troublesome patients, but reports from NGOs have affirmed that this occurs far too frequently in understaffed and undertrained detention centers across the country – segregation has even been used as a punitive measure for detainees with mental health issues. Obviously, the punitive use of segregation creates a significant disincentive for detainees to seek help for mental health issues, and it widens the chasm between the patients and health professionals working in detention settings. Furthermore, it effectively silences any questions or concerns that detainees might wish to raise in regard to their human rights. Even more serious, however, is that the use of segregation on people who have suffered torture and other grave human rights abuses severely exacerbates the mental anguish they feel on a daily basis, particularly if placement in solitary confinement was part of their torture experience. Therefore, reintroduction of this devastating method of control, this time at the hands of US detention center staff, frequently re-awakens their trauma and serves to greatly worsen their mental health issues.

[2] [3] There is a great deal of variance in the terminology dealing with this issue. Clinicians and security staff use the terms “segregation”, “isolation”, “seclusion” and “solitary confinement” to describe the situation where a detainee is placed alone in a small cell for 23 hours per day, separated from other people, and frequently in the dark. This scenario may be distinguished from “administrative segregation” (when detainees may be temporarily separated to prevent them from collaborating) or “medical isolation” (when a detainee is physically separated from the rest of the population because he has a contagious disease, but is kept in a glass-walled room so that he can continue to have human interaction).